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Management of herpes simplex virus type 1 pneumonia following liver transplantation

Herpes simplex Typ 1-Pneumonie nach Lebertransplantation

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Summary

Interstitial pneumonia caused by Herpes simplex virus type 1 (HSV-1) is a severe complication of orthotopic liver transplantation (LTX). The records of patients were reviewed who had an LTX at the age of 16 years or older between 1991 and 1994 with a mean follow-up of 21 months (range, 10 to 44 months). Six patients were included who had fever of >38°C, deterioration of arterial blood gases, radiological evidence of interstitial pneumonia and proof of HSV-1 in bronchoalveolar lavage fluid. All patients were anti-HSV-IgG positive before LTX. All patients were successfully treated with intravenous acyclovir, mechanical ventilation and reduced immunosuppression. Three patients who received cyclosporin A had a rejection which was successfully treated by switching to FK 506. Four patients were discharged in good health. One patient died 36 months after LTX of an unrelated cause. One patient died of urosepsis on postoperative day 139. Acyclovir together with mechanical ventilation and reduced immunosuppression proved to be an effective treatment for HSV-1 pneumonia following LTX.

Zusammenfassung

Die von Herpes Simplex Virus Typ 1 (HSV-1) verursachte interstitielle Pneumonie ist eine schwere Komplikation der orthotopen Lebertransplantation (LTX). Wir werteten die Akten von allen Patienten über 16 Jahre aus, die 1991–1994 eine LTX erhielten mit einer mittleren Verlaufsbeobachtung von 21 Monaten (10–44 Monate). Sechs Patienten erfüllten die diagnostischen Kriterien für eine HSV-Pneumonie mit Fieber >38°C, verschlechterter arterieller Blutgasanalyse, radiologischen Zeichen einer interstitiellen Infiltration und Nachweis von HSV-1 in der bronchoalveolären Lavageflüssigkeit. Vor der Transplantation waren alle Patienten anti-HSV-IgG positiv. Alle Patienten wurden erfolgreich behandelt mit Acyclovir, Beatmung und reduzierter Immunsuppression. Drei Patienten unter Cyclosporin A hatten eine Abstoßung, die durch Umstellung auf FK 506 erfolgreich behandelt wurde. Vier Patienten wurden in gutem Zustand entlassen. Ein Patient starb 36 Monate nach LTX an einer anderen Erkrankung. Ein Patient verstarb an Urosepsis am postoperativen Tag 139. Gabe von Acyclovir, reduzierte Immunsuppression und Beatmung ist eine effektive Behandlung der HSV-1 Pneumonie nach Lebertransplantation.

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References

  1. Allen, K. A., Markin, R. S., Rennard, S. I., Shaw, B. W., Thompson, A. B., Wood, R. P., Woods, G. S., Linder, J. Bronchoalveolar lavage in liver transplant patients. Acta Cytol. 33 (1989) 539–543.

    Google Scholar 

  2. Jensen, W. A., Rose, R. M., Hammer, S. M., Jenkins, R. L., Bothe, A., Benotti, P. N., Dzik, W. H., Costello, P., Khettry, U., Trey, C., Eliopoulos, G. M., Karchmer, A. W. Pulmonary complications of orthotopic liver transplantation. Transplantation 42 (1986) 484–490.

    Google Scholar 

  3. Paya, C. V., Hermans, P. E., Washington, J. A., Smith, T. F., Anhalt, J. P., Wiesner, R. H., Krom, R. A. F. Incidence, distribution, and outcome of episodes of infection in 100 orthotopic liver transplantations. Mayo Clin. Proc. 64 (1989) 555–564.

    Google Scholar 

  4. Singh, N., Dummer, J. S., Kusne, S., Breinig, M. K., Armstrong, J. A., Makowka, L., Starzl, T. E., Ho, M. Infections with cytomegalovirus and other herpesviruses in 121 liver transplant recipients: transmission by donated organ and the effect of OKT3 antibodies. J. Infect. Dis. 158 (1988) 124–131.

    Google Scholar 

  5. Cuervas-Mons, V., Martinez, A. J., Dehler, A. Adult liver transplantation: an analysis of the early causes of death in 40 consecutive cases. Hepatology 6 (1986) 495–501.

    Google Scholar 

  6. Connolly, M. G., Baughman, R. P., Dohn, M. N., Linnemann, C. C. Recovery of viruses other than cytomegalovirus from bronchoalveolar lavage fluid. Chest 105 (1994) 1775–1781.

    Google Scholar 

  7. Prellner, T., Flamholc, L., Haidl, S., Lindholm, K., Widell, A. Herpes simplex virus — the most frequently isolated pathogen in the lungs of patients with severe respiratory distress. Scand. J. Infect. Dis. 24 (1992) 283–292.

    Google Scholar 

  8. Ramsey, P. G., Fife, K. H., Hackman, R. C., Meyers, J. D., Corey, L. Herpes simplex virus pneumonia. Ann. Int. Med. 97 (1982) 813–820.

    Google Scholar 

  9. Colonna, J. O., Winston, D. J., Brill, J. E., Goldstein, L. I., Hoff, M. P., Hiatt, J. R., Quinones-Baldrich, W., Ramming, K. P., Busuttil, R. W. Infectious complications in liver transplantation. Arch. Surg. 123 (1988) 360–364.

    Google Scholar 

  10. Kusne, S., Dummer, J. S., Singh, N., Iwatsuki, S., Makowka, L., Esquivel, C., Tzakis, A. G., Starzl, T. E., Ho, M. Infections after liver transplantation. Medicine 67 (1988) 132–143.

    Google Scholar 

  11. Kusne, S., Schwartz, M., Breinig, M. K., Dummer, J. S., Lee, R. E., Selby, R., Starzl, T. E., Simmons, R. L., Ho, M. Herpes simplex virus hepatitis after solid organ transplantation. J. Infect. Dis. 163 (1991) 1001–1007.

    Google Scholar 

  12. Singh, N., Mieles, L., Yu, V. L., Starzl, T. E. Decreased incidence of viral infections in liver transplant recipients. Possible effects of FK 506? Dig. Dis. Sci. 39 (1994) 15–18.

    Google Scholar 

  13. Uemoto, S., Tanaka, K., Fujita, S., Sano, K., Shirahase, I., Kato, H., Yamamoto, E., Inomata, Y., Ozawa, K. Infectious complications in living related liver transplantation. J. Ped. Surg. 29 (1994) 514–517.

    Google Scholar 

  14. Zitelli, B. J., Gartner, J. C., Malatack, J. J., Urbach, A. H., Miller, J. W., Williams, L., Kirkpatrick, B., Breinig, M. K., Ho, M. Pediatric liver transplantation: patient evaluation and selection, infectious complications, and life-style after transplantation. Transpl. Proc. 19 (1987) 3309–3316.

    Google Scholar 

  15. Ruben, F. L., Nguyen, M. L. T. Viral pneumonitis. Clin. Chest Med. 12 (1991) 223–235.

    Google Scholar 

  16. Graham, B. S., Snell, J. D. Herpes simplex virus infection of the adult lower respiratory tract. Medicine 62 (1983) 384–393.

    Google Scholar 

  17. Bismuth, H. European Liver Transplant Registry. Hôpital Paul Brousse Villejuif, France 1994.

    Google Scholar 

  18. Wiest, P. M., Flanigan, T., Salata, R. A., Shlaes, D. M., Katzman, M., Lederman, M. M. Serious infectious complications of corticosteroid therapy for COPD. Chest 95 (1989) 1180–1184.

    Google Scholar 

  19. Paya, C. V., Hermans, P. E., Smith, T. F., Rakela, J., Wiesner, R. H., Krom, R. A. F., Torres, V. E., Sterioff, S., Wilkowske, C. J. Efficacy of gancyclovir in liver and kidney transplant recipients with severe cytomegalovirus infection. Transplantation 46 (1988) 229–234.

    Google Scholar 

  20. Schiffer, J., Mentha, G., Giostra, E., Belli, D., LeCoultre, C., Rohner, A. Cytomegalovirus in liver transplantation: incidence and groups at risk. Schweiz. Med. Wochenschr. 12 (1994) 631–636.

    Google Scholar 

  21. Arnow, P. M. Infections following orthotopic liver transplantation. HPB Surgery 3 (1991) 221–233.

    Google Scholar 

  22. Lawin, P. Praxis der Intensivbehandlung. Thieme, Stuttgart, New York 1994, p. 1001.

    Google Scholar 

  23. Forth, W., Henschler, D., Rummel, D.: Pharmakologie und Toxikologie. Bibliographisches Institut Mannheim 1980, pp. 344–345.

  24. Meyers, J. D., Reed, E. C., Shepp, D. H. Acyclovir for prophylaxis of cytomegalovirus infection and disease after allogeneic marrow transplantation. NEJM 318 (1988) 70–75.

    Google Scholar 

  25. Selby, P., Rowles, R. L., Easton, D., Perren, T. J., Stolle, K. The prophylactic role of intravenous and long-term oral acyclovir after allogeneic bone marrow transplantation. Br. J. Cancer 59 (1989) 434–438.

    Google Scholar 

  26. Taylor, C. E., Sviland, L., Pearson, A. D. J., Dobb, M., Reid, M. M., Kernakan, J., Craft, A. W., Hamilton, P. J., Proctor, S. Virus infections in bone marrow transplant recipients: a three-year prospective study. J. Clin. Pathol. 43 (1990) 633–637.

    Google Scholar 

  27. Schlech, W. F., Meagher, N., Cohen, A. D., Belitsky, P., MacDonald, S. A randomized double-blind placebo controlled trial of oral acyclovir in renal allograft recipients. Can. J. Infect. Dis. 4 (1993) 84–88.

    Google Scholar 

  28. Tang, I. Y. S., Maddux, M. S., Veremis, S. A., Bauma, W. D., Pollak, R. Low-dose oral acyclovir for prevention of herpes simplex virusinfection during OKT3 therapy. Transpl. Proc. 21 (1989) 1758–1760.

    Google Scholar 

  29. Stratta, R. J., Shaefer, M. S., Cushing, K. A., Markin, R. S., Reed, E. C. A randomised prospective trial of acyclovir and immunoglobulin prophylaxis in liver transplant recipients receiving OKT 3 therapy. Arch. Surg. 127 (1992) 55–64.

    Google Scholar 

  30. Mollison, L., Richards, M., Johnson, P., Angus, P., Hayes, K.: Acyclovir reduces cytomegalovirus disease after liver transplantation. Hepatology 14 (1991) 285A.

  31. Anderson, P. J., Jordan, M. C. Viral pneumonia in recipients of solid organ transplants. Sem. Resp. Infect. 5 (1990) 38–49.

    Google Scholar 

  32. Wagstaff, A. J., Faulds, D., Goa, K. L. Acyclovir, a reappraisal of its antiviral activity, pharmacokinetic properties and therapeutic efficacy. Drugs 47 (1994) 153–205.

    Google Scholar 

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Liebau, P., Kuse, E., Winkler, M. et al. Management of herpes simplex virus type 1 pneumonia following liver transplantation. Infection 24, 130–135 (1996). https://doi.org/10.1007/BF01713317

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